Groin Swellings
These are common clinical problems, especially hernias. They are therefore common in clinical examinations.
Causes
Above The Inguinal Ligament
Below The Inguinal Ligament
History
Sebaceous cyst
The patient will complain of a mobile lump on the skin. It may be red and inflamed and discharging.
Lipoma
The patient will present with a soft, painless swelling.
Hernias
A patient with a groin hernia will present with a lump that disappears on recumbency or may be pushed back (reducible). The patient may present with a tense, tender lump that will not reduce and is accompanied by signs and symptoms of intestinal obstruction. Femoral hernia is more common in females. With hernias, there is occasionally a history of sudden straining or trauma, following which a lump may become manifest.
Imperfectly descended testis
An imperfectly descended testis may present as a groin swelling. The patient, or, if in a young child, the mother, will have noticed absence of a testis from the scrotum. Enlargement and pain may indicate malignant change, which is more common in an imperfectly descended testis.
Lipoma of the cord
The patient will have noticed a soft swelling in the groin. This is often mistaken for a hernia.
Hydrocele of the cord
This may present as a lump in the inguinal region which does not reduce.
Hydrocele of the canal of Nuck
This is similar to a hydrocele of the spermatic cord but presents in the female. It represents a cyst forming in the processus vaginalis.
Lymph nodes
Lymph nodes may present as swellings below the inguinal ligament. They may be discrete and firm, tender and red or matted to form a mass. The patient may have noticed a lesion on the leg. Care must be taken to elicit a full history with inguinal lymphadenopathy, as the nodes drain not only the tissues of the leg but also the penis, the scrotal skin, the lower half of the anal canal, the skin of the buttock and the skin of the lower abdominal wall, up to and including the umbilicus. In the female, they drain the labia, the lower third of the vagina and the fundus of the uterus, via lymphatics accompanying the round ligament down the inguinal canal. A careful history should therefore be taken, of any anorectal disease, e.g. bleeding PR, or gynaecological disease, e.g. bleeding PV to suggest a carcinoma of the uterus.
Saphena varix
A saphena varix is normally associated with varicose veins lower down the leg. The patient will present having noticed a small, soft, bluish mass in the lower part of the groin.
Femoral artery aneurysm
A pulsatile expansile mass suggests a femoral aneurysm. Check for a history of arterial surgery at the groin or arteriography via the femoral artery, which may suggest the presence of a false aneurysm.
